Upper secondary school diploma and mental health in emerging adulthood: examining the severity and co-occurrence of depression and anxiety symptoms.

BACKGROUND A significant proportion of young people in Sweden do not graduate from upper secondary school with a complete diploma, which may be crucial for their mental health. A diploma influences both perceived and actual future prospects, including access to tertiary education and employment opportunities. Additionally, education fosters personal control and problem-solving skills relevant to stress management and self-esteem. Therefore, this study explores the association between obtaining an upper secondary diploma and the severity and co-occurrence of depression and anxiety symptoms among emerging adults in Sweden. METHODS Data from a population-based cohort of Swedish 21-year-olds (n=3255) were analysed. Depression and anxiety symptoms were measured using the Patient Health Questionnaire-4 (PHQ-4). Registry data provided information on upper secondary education, sex, immigrant background, and parental education. Multinomial logistic regression was used. RESULTS Participants without an upper secondary diploma were at a higher risk of experiencing the most severe outcomes; that is, severe symptoms (vs. normal/mild) and co-occurring depression and anxiety symptoms (vs. no symptoms) compared with those with an academic diploma. They also had a higher risk of depression only, but not anxiety only. Additionally, compared with participants with an academic diploma, those with a vocational upper secondary diploma exhibited an elevated risk of depression only. CONCLUSIONS This study highlights the link between an upper secondary diploma and mental health in emerging adulthood. It also suggests that depression, anxiety, and their co-occurrence may have distinct determinants. The findings indicate that initiatives to support school completion and re-engagement could have significant public health benefits.